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Psychiatry > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What are the factors in the Five-factor model?

A 
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
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2
Q

ICD 10 says that the enduring patterns of inner experience and behaviour seen in personality disorder must manifest more than 1 of which areas?

A

cognition (ways of interpreting self & others)
affectivity (range, intensity & appropriateness of emotional response)
interpersonal functioning
impulse control

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3
Q

Are personality disorders triggered by certain stimuli or situations?

A

No they have to be pervasive, inflexible, maladaptive or dysfunctional across a broad range of personal and social situations.

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4
Q

Anankastic personality disorder is characterised by what?

A

Feelings of excessive doubt and caution.
Preoccupation with details, rules, lists, order, organisation etc.
Perfectionism that interferes with task completion.
Rigidity & stubbornness.

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5
Q

What is the difference between a trait and a disorder?

A

It is a disorder only if it is pervasive, causes distress ± causes impairment of functioning in most areas.

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6
Q

Which personality disorders might you see in cluster A of DSM-V?

A

paranoid
schizoid
schizotypal

“odd and eccentric”

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7
Q

Which personality disorder might you see in cluster B of DSM-V?

A

Antisocial/Dissocial
Emotionally unstable (impulsive or borderline)
Histrionic
(Narcissistic - not in ICD-10)

“dramatic and emotional”

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8
Q

Which personality disorders might you see in cluster C of DSM-V?

A

Anxious (Avoidant)
Dependent
Anankastic

“Anxious and avoidant”

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9
Q

Paranoid personality disorder has which characteristics?

A 
4 of:
Excessive sensitivity to setbacks
Tends to bear grudges
Recurrent suspicions 
Persistent self-referential attitude associated particularly with excessive self-importance. 
Preoccupied with conspiracies.
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10
Q

What features might you see in schizoid PD?

A 
4 of:
Emotional coldness / flattened affect.
Few if any activities provide pleasure.
Indifferent to praise or criticism of others.
Little interest in sex.
Choses solitary activities.
No close friends/relationships.
Insensitive to prevailing social norms.
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11
Q

What features might you see in schizotypal PD?

A 
5 or more of:
Ideas of reference
Odd beliefs/magical thinking
Odd thinking and speech.
Suspicious 
Inappropriate affect
Behaviour and appearance that is odd, eccentric or peculiar. 
Lack of close friends.
Excessive social anxiety that doesn't diminish with familiarity.
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12
Q

Which features might you see in antisocial PD?

A

3 of:
callous unconcern for feelings of others.
Disregard for social norms (e.g. burglary)
Incapable of maintaining enduring relationships (no problem establishing them)
Easily frustrated / aggressive
Unable to feel guilty
Often blames others.

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13
Q

What features might you see in the Impulsive variant of emotionally unstable PD?

A

3 of:
unexpected acts with no regard for consequences
quarrelsome behaviour
liable to outburst of anger/violence
unstable mood
difficulty completing a task if offers no immediate reward

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14
Q

What features might you see in the borderline variant of emotionally unstable PD?

A 
Disturbances in/uncertainty about self-image, aims & internal preferences.
Intense & unstable relationships
Excessive efforts to avoid abandonment
Recurrent threats/acts of self-harm.
Chronic feelings of emptiness
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15
Q

What features might you see in histrionic PD?

A

self-dramatisation / exaggerated emotions
shallow affect
likes to be centre of attention
inappropriately seductive
overly concerned with physical attractiveness.

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16
Q

What features might you see in Narcissistic PD?

A

Fixed fantasises of infinite success, control, beauty, brilliance etc.
Belief that they are extraordinary/exceptional and can only be understood by similar people.
Sense of entitlement
Wants unwarranted admiration.
No form of empathy
Resentment of others
Egotistical and conceited behaviours / attitudes.

17
Q

What features might you see in anxious PD?

A

Belief that they are socially inept/inferior to others.
Excessive worrying about being criticised/rejected in social situations.
Unwilling to get involved with people unless certain of being liked.
Restrictions in lifestyle due to need for security.
Avoiding social activities that involve interpersonal contact due to fear of criticism.

18
Q

What features might you see in dependent PD?

A

Allowing others to make their important life decisions.
Subordination of their own needs to those on which they are dependent.
Won’t make even reasonable demands of dependents.
Feels uncomfortable / helpless when alone due to fears of inability to care for themselves.
Unable to make everyday decisions without lots of advice/ reassurance.

19
Q

Which personality disorders may improve with the use of low dose antipsychotic drugs?

A

All 3 cluster A disorders - reduce suspiciousness.

Borderline PD - if patient is paranoid or hearing voices.

20
Q

In which PD might an antidepressant be useful?

A

Cluster B disorders - helps with mood and emotional difficulties.
Borderline line & antisocial - some SSRIs can help reduce impulsiveness and aggression.
Cluster C disorders - reduce anxiety.

21
Q

In which PDs might mood stabilisers be useful?

A

Borderline disorder - help with unstable mood and impulsivity.

22
Q

What would be the 1st line drug to help with affective dysregulation?

A

SSRI or mirtazepine

23
Q

What would be the 1st line to help with difficulties with impulse control?

A

SSRI

then olanzapine

24
Q

What is the mainstay treatment for emotionally unstable PD?

A

Dialectical Behavioural Therapy (DBT)

25
Q

What is the aim of DBT?

A

Goal = learn to accept and regulate emotions.

Balance between acceptance of yourself and making positive changes in your life.

26
Q

Give some examples of individual lessons in DBT?

A

learning new skills to replace harmful behaviour
reduce suicidal & self-harm behaviour
Address mental health/personal problems
Reduce therapy interfering behaviours.

27
Q

What is mentalisation?

A

process by which we interpret our own actions as being meaningful, based on our own internal mental states

28
Q

What is the goal of mentalisation?

A

To better understand and control impulses, emotions and behaviours and improve relationships.

29
Q

What is STEPPS?

A

Systems Training for Emotional Predictability and Problem Solving
CBT based skill training programme, focusing on stabilisation. An Add-on to usual treatment; 20 weeks + homework; significant others are involved.

Psychiatry (6 decks)

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